Retrospective cohort study reveals higher initial seizure cessation with phenobarbitone versus levetiracetam in neonates, indicating superior acute efficacy.
Key Points
To compare the clinical efficacy and safety profiles of phenobarbitone versus levetiracetam as first-line antiepileptic treatment for neonatal seizures.
Retrospective cohort study conducted over 1.5 years (April 2021 to October 2022) in a single NICU in Gujarat, India.
Evaluated 45 neonates receiving either phenobarbitone (n=24) or levetiracetam (n=21) for seizure management.
Outcomes included immediate seizure cessation, need for secondary reloading doses, adverse effects, breakthrough seizures, and 6-month neurodevelopment using the Hammersmith Infant Neurological Examination (HINE).
Immediate seizure cessation after the initial loading dose occurred in 10/24 (41.67%) infants receiving phenobarbitone compared with 3/21 (14.29%) receiving levetiracetam (p=0.04).
A secondary reloading dose was required by 14/24 (58.33%) neonates in the phenobarbitone cohort versus 18/21 (85.71%) in the levetiracetam cohort (p=0.04).
Documented in-hospital adverse events, post-discharge breakthrough recurrence rates, and 6-month neurodevelopmental trajectories showed no statistically significant differences between groups.